NONDIABETIC HYPOGLYCEMIC PATIENT

We all remember that beta blockers should be used cautiously in diabetic patients because these agents can blunt the symptoms of hypoglycemia. Recently, I have had quite good results using beta blockers in a few nondiabetic patients with symptomatic hypoglycemia for whom dietary changes alone weren’t enough. Have you heard of this use before? Is anyone researching this as a possible treatment option?—Charles Smith, MD, Holdrege, Neb.

True hypoglycemia is rare in patients not being treated for diabetes. The differential diagnosis of hypoglycemia in a nondiabetic patient is extensive; possible causes range from surreptitious use of insulin or sulfonylureas to insulinoma to alcohol-related hypoglycemia in malnourished alcoholics. The workup required depends on which type of hypoglycemia the patient has; fasting or postprandial testing would ideally be done while the patient is hypoglycemic. It is conceivable that beta blockers can blunt symptoms of hypoglycemia by blocking the neurogenic autonomic discharge that results in palpitations and tremulousness. I would not treat the symptoms, however, especially not before confirming the diagnosis and elucidating the etiology.—Susan Kashaf, MD, MPH (103-9)

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